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Objective To evaluate the effects of body weight-supported overground gait training (BWSOGT) on motor abilities, such as gait and balance, in patients with Parkinson’s disease (PD). Design Retrospective case-controlled observational study with a 4-week follow-up. Setting Inpatient rehabilitation. Participants We selected 37 of 68 patients with PD. Inclusion criteria were (1) Hoehn & Yahr stage II–IV, (2) no medication adjustment during the study period, (3) at least 1 week since last medication adjustment, and (4) ability to walk more than 10 meters on their own. Exclusion criteria were (1) cerebrovascular disease or other complications affecting movement, (2) difficulty in measurement, (3) early discharge, (4) medication change during the study, and (5) development of complications. Interventions Patients were divided into two groups. Patients in Group I underwent 20 minutes of BWSOGT with a mobile hoist in addition to the standard exercises; Group II performed 20 minutes of gait training in place of BWSOGT. In both groups, training was performed for a total of 15 times/4 weeks. Main outcome measure(s) Participants were evaluated using the Unified Parkinson’s Disease Rating Scale total, part II, and part III; 10-m walk test; velocity; stride length; 6-minute walk test; timed up and go test; Berg Balance Scale; and freezing of gait before and after the intervention. Results There were significant decreases in the Unified Parkinson’s Disease Rating Scale total, part II, and part III in both groups; however, 6-minute walk test, timed up and go test, and freezing of gait results only improved in Group I. Conclusions BWSOGT for patients with PD improves gait ability and dynamic balance more than standard gait training.

Intracranial epidermoid cysts are rarely known to increase in size over a brief period. While malignant transformations of epidermoid cyst have been previously described, no reports to date have described rapid proliferation accompanied by mature hair follicles and sebaceous glands without malignant transformations. The present case involved a 71-year-old man who visited a local physician with disturbance of equilibrium. A mass lesion was detected at the left cerebellopontine angle and was subsequently removed. Histopathological diagnosis of this lesion was as an epidermoid cyst. Seventeen years after this initial surgery, worsened left hypoacusis, disorientation, eating disorder and gait disturbance appeared, and the patient visited the physician again. Local recurrence of the lesion was observed, and the patient was referred to our hospital for its removal. Intraoperative findings revealed a pearly white tumor, histopathologically diagnosed as an epidermoid cyst. Three years later, local recurrence was observed, and the cyst was again removed. Intraoperative findings revealed a partially pearly white tumor similar to the tumor observed during the second surgery, but the majority of the tumor was non-shiny, ochre-colored and suckable. Histopathological diagnosis was an epidermoid cyst with an epidermis-like structure. Postoperative activities of daily living were independent thereafter, but from March of the following year, he began to experience increasing difficulty in walking and subsequently visited our hospital again. Tumor recurrence was observed and was removed again in November of the same year. Intraoperative findings revealed a tumor that was primarily ochre-colored, non-shiny, brittle and suckable. The histopathological diagnosis was folliculosebaceous epithelial proliferative lesion accompanied by an epidermis-like epithelium and a differentiation into hair follicles and sebaceous gland,s and the tumor was determined to be an epidermoid cyst with proliferative folliculosebaceous epithelium.

Fibrous or transitional meningioma and solitary fibrous tumor (SFT) are frequently difficult to differentiate from each other on the basis of histopathology. It is extremely unusual for a meningioma to exhibit diffuse, strongly positive immunoreactivity for cluster of differentiation 34 (CD34), and this has never been previously reported from a histopathological specimen. A patient with transitional meningioma that exhibited strongly positive for CD34, which has been regarded as characteristic of SFT and is considered to be useful for distinguishing the latter from meningioma, is reported.

We aimed to evaluate the clinical efficacy of monotherapy with alendronate and combined therapy with alendronate and menatetrenone (vitamin K2 [VitK2]) in postmenopausal rheumatoid arthritis (RA) patients with osteoporosis or osteopenia. Sixty-two postmenopausal RA patients with untreated osteoporosis or osteopenia (lumbar spine bone density ≤80 % of young adult mean [YAM]) were enrolled: 39 had abnormal serum undercarboxylated osteocalcin (ucOC) levels (>4.5 ng/mL) and received combined therapy with alendronate (35 mg/week) and VitK2 (45 mg/day) (ALN + K group); 23 had normal ucOC levels (≤4.5 ng/mL) and received alendronate monotherapy (35 mg/week) (ALN group). The clinical results for the 57 patients in both groups were evaluated after 1-year treatment. The mean baseline/follow-up (FU) lumbar spine bone density (%YAM) values were 73.0/76.8 % (P

Purpose: To evaluate the incidence, character, and prognosis of ovarian tumors diagnosed as benign before laparoscopic surgery but identified as malignant or of borderline malignancy by postoperative histopathology.Subjects: Of 1,066 laparoscopic ovarian tumor resections at Tohoku Kosai Hospital from April 2001 to May 2010, a total of 22 patients were postoperatively confirmed as having overt or borderline malignancies. Methods: For this patient subset, the following factors were analyzed: postsurgical histopathology, patient age, tumor size, solid tumor component, CA125 and CA19-9 markers, laparoscopic technique, tumor capsule status, adjunctive therapy, and prognosis.Results: The rate of preoperative diagnostic error was 2.2% (22/1,066). Of the 22 misinterpreted tumors, five were clearly malignant, and 17 were of borderline malignant potential. Although no specific tendencies were evident, based on analysis of preoperative features, malignant lesions were more likely in older patients or in those with large sized cysts. For two of the five patients with malignancies, definitive cancer surgery was performed, followed by chemotherapy, while the other three received chemotherapy alone. Three of the 17 patients with borderline malignancy also opted for surgery. Endometrial carcinoma was found in one patient with malignancy, and recurrent mucinous cysts occurred in two patients with borderline tumors, but the long-term prognosis for these patients in close follow-up was fairly good.Conclusion: Preoperative misdiagnosis of ovarian malignancies may be unavoidable, despite thorough assessment. However, even with laparoscopic resection, the prognosis of such tumors is not poor, given adequate adjunctive therapy and/or careful clinical follow-up.

1972年，英国のハンスフィールドにより開発されたX線CT装置は，今日までその進展を止めることなく変遷を遂げており，マルチスライスCT装置 (MSCT) の開発と更なる多列化により飛躍的にスキャン時間が短縮され，画質が向上してきた。これにより病態の把握や手術支援，患者への説明におけるボリュームレンダリング (VR) や最大値投影法 (MIP)，Multi Planar Reformation (MPR)，Curved Planar Reconstruction (CPR) 等の有用性は今まで以上に大きくなったといえる。

腹部動脈瘤の手術のさいに偶然指摘される小さな嚢胞も含めると,腎嚢胞を合併する腹部動脈瘤は希ではないと思われるが,本邦での腎嚢胞あるいは嚢胞腎を伴った腹部大動脈瘤手術の報告はきわめて少ない.大きな腎嚢胞は動脈瘤の手術中に腎嚢胞が破裂・出血の報告もあり,さらに手術操作に支障をきたすこともあり,なんらかの対策が必要である.今回,77歳,男性の腹腔を圧迫する両側巨大多発性腎嚢胞を合併した腹部動脈瘤に対して,術前に巨大な両側腎嚢胞を超音波ガイド下に経皮的に穿刺吸引を行い約1,550mlを除去した.3日後,5.2cmの大動脈瘤と3.0cmの左総腸骨動脈瘤,2.6cm右総腸骨動脈瘤に対して腹部正中切開,腹膜外到達法で動脈瘤切除+Y字型人工血管置換術を施行した.術後経過は順調で,巨大な嚢胞性腎疾患を合併する腹部動脈瘤に対し経皮的穿刺内容液吸引は有用な方法であった.

Purpose: To study the effect of cyclosporin (CsA) on steroid-induced cataracts in patients following renal transplantation. Methods: The subjects comprise 140 patients who had undergone renal transplantation at Kanazawa Medical Hospital. These subjects had received ophthalmologic examinations prior to their surgery and subsequently over the span of 12 months following surgery. The charts of these patients were re-examined for this study. The subjects were divided into two groups: the conventional therapy group (Group C) that received azathioprine and methylprednisolone; and the triple therapy group (Group T) that received azathioprine, methylprednisolone, and CsA. There were 73 and 67 patients in Groups C and T, respectively. The cataracts were classified according to Crews' classification. Steroid-induced cataract was diagnosed when vacuoles were observed or opacity was evident in the posterior subcapsular region. Subjects who exhibited any lens opacity before renal transplantation were excluded from this study. Results: The total amounts of systemic steroid administered during the first year and at the final observation period were significantly lower in Group T than in Group C. The prevalence of steroid-induced cataracts of grade 1 and above was 55% and 63% for the first year, 73% and 89% for the second year, 74% and 92% for the third year, and 83% and 96% for the fifth year in Groups C and T, respectively. By the third year, the percentage of subjects exhibiting corrected visual acuity

An 85-year-old woman was hospitalized with severe melena of unknown origin. Upper gastrointestinal (GI) endoscopy and lower GI endoscopy did not detect the origin and we could not establish any diagnosis. To explore the bleeding site, 99mTc-HSA blood loss scintigraphy was performed and a tumor of the small intestine was suspected. Fluoroscopic examination of the small intestine and abdominal CT scan confirmed an ileal tumor measuring 4×3 cm. The mass was a well-demarcated tumor about 80 cm proximal to Bauhin's valve. Partial resection of the ileum was carried out and the tumor was histologically diagnosed as schwannoma. Thereafter, there has been no recurrence of melena nor metastasis of the tumor. It is thought that blood loss scintigraphy is a useful method for unexplained exacerbation of melena.(Internal Medicine 42: 1178-1182, 2003)

目的: いわゆる顎関節症患者のなかには, 顎口腔系の諸症状に加えて慢性的な頭痛や頭頸背部痛などを訴えるものが少なくない. しかしながら, これまで用いられてきた顎関節症の細病態分類に基づいて治療を進めた場合, ややもするとこれら随伴症状と呼ばれてきた患者の訴えに対する適切な対応がなおざりにされがちとなることは否めない. そこで本研究では, 顎関節症の細病態分類と患者の訴えた主要症状との関連を検討することにより, 現行の分類システムに望まれる改善点などについて考察した.方法: 対象者は, 1994年4月から1998年3月までに顎関節症状あるいは口腔顔面痛を主訴に岡山大学歯学部附属病院第1補綴科を受診した連続患者サンプル393例である. 対象者に対し, 顎関節症の細病態分類ならびに訴えの分類を行い, 両者をつき合わせ, その整合性について検討した.結果: 訴えの頻度を分析すると, 顎関節症の三大症状と呼ばれる「顎の痛み」が49.6%, 「開 (閉) 口障害」が32.6%, 「関節雑音」が30.8%と多くを占める一方, 「頭痛, 頭部の痛み」が6.9%, 「咀嚼障害, 咬合不全」が6.1%, 「首, 肩のこり・痛み」が5.9%と三大症状に含まれない訴えが各病態に少なからず存在した.結論: 顎関節症の三大症状以外の症状を訴えて来院する患者もけっして少なくないことが明らかとなった.顎関節症の細病態分類に加えてこれらの訴えにも適切に対応するためには, 複数診断を許す診断システムの確立が必要であると考えられた.

Increased plasma levels of von Willebrand factor antigen (vWF:Ag) are regarded as reflecting the release reaction by vascular endothelial cells and/or endothelial cell injury, and increased levels of thrombomodulin (TM) antigen as reflecting damage to endothelial cells. We investigated changes in plasma vWF:Ag and TM antigen levels during the course of regular hemodialysis treatment (RDT) in 14 patients undergoing RDT in order to evaluate the effect of hemodialysis (HD) on endothelial cells. vWF:Ag and TM were both measured by the sandwich EIA method. Predialysis levels of vWF:Ag and TM in RDT patients were both significantly higher than normal control values. Neither patient age nor blood pressure was not correlated with predialysis vWF:Ag and TM levels. Both vWF:Ag and TM levels significantly increased during a single HD session. There was a positive correlation between predialysis TM levels and duration of HD and an inverse correlation between the amount of vWF:Ag released during HD and duration of HD. It appears that HD procedures induce stimulation and damage of endothelial cells and that long-term, recurrent HD treatment may predispose to vascular disorders.

Background: The present study was conducted to investigate how patients with clinically localized prostate cancer were treated in the Hokuriku District, Japan. Methods: Medical records of 536 patients with stage B prostate cancer were retrospectively reviewed. The patients were diagnosed and treated at four university hospitals and 32 collaborating hospitals in the Hokuriku District. Results: Because their medical records were incomplete and/or they not available for follow up, 79 cases were excluded from this study. Conservative treatment with hormone therapy was used for 248 cases. Radical prostatectomy was performed in 199 cases, only 27 of whom underwent surgical monotherapy. There was no significant difference in disease-specific survival rates between the hormone (69.0%) and surgery group (83.2%) after 110 months. Results of the analysis of disease-specific survival rates according to histologic grade showed that patients with poorly differentiated cancers treated with hormone therapy were the only subset with significant differences when compared against the other patients. Conclusion: The value of prostatectomy alone or added was marginal in terms of survival. Only patients with poorly differentiated cancer might benefit from prostatectomy.

Purpose To study the effect of cyclosporin on steroid-induced cataract in patients after renal transplantation. Subjects and methods 140 patients who received renal transplantation and ophthalmological examinations before and over 12 months after surgery at Kanazawa Medical University were investigated retrospectively. The subjects were divided into the following two groups: the conventional therapy group(Group C) who were administered azathioprin and methylprednisolone and the triple therapy group(Group T) who were administered azathioprin, methylprednisolone and cyclosporin. There were 73 subjects in group C and 67 in group T. Judgement of steroid cataract followed Crew's classification and steroid cataract was diagnosed when vacuoles or opacity were seen in the posterior subcapsular region. Subjects that had any lens opacity before renal transplantation were excluded. Results The total dose of systemic steroid during the first year and in the final observation period in group T was significantly higher than in group C. The prevalence of steroid cataract was 55% and 63% for the 1st year, 72% and 89% for the 2nd year, 74% and 92% for the 3rd year and 83% and 96% for the 5th year in groups C and T, respectively. By the third year, the rate of subjects whose corrected visual acuity was less than 0.8 or who received cataract surgery was significantly higher in group T than in group C. There was no significant difference in the total dose between the subjects with cataract over grade I and those of grade 0 and I in both groups C and T. In group C, the total dose of steroid pulse therapy was significantly higher in the subjects with steroid cataract over grade I than in those with grade 0 and I. Conclusions Using cyclosporin, although the total dose of systemic steroid was decreased, the rate of steroid cataract increased. Cyclosporin may accelerate the development of steroid cataract. Steroid pulse therapy is considered to be a risk factor for developing steroid cataract.

Hemolytic uremic syndrome (HUS) is a rare but serious complication following renal transplantation. It usually develops early after transplantation, and ciclosporin treatment is the most common triggering factor. We report the case of a 35-year-old male with posttransplant HUS which developed 1 year after renal transplantation. He became febrile 4 days before the onset of HUS, and the significant rise in viral titer confirmed the diagnosis of influenza A virus infection. The association of ciclosporin treatment with HUS was unlikely, because of the late onset of HUS and the low ciclosporin trough levels. The patient was treated successfully without a dose reduction of ciclosporin. An etiologic relationship between influenza A virus and HUS was highly probable in our patient. We also review a total of 156 adult cases with HUS after renal transplantation described in the literature. The prognosis of posttransplant HUS differs according to the cause. The advent of ciclosporin has improved the graft survival rate and mortality of patients with rejection-induced HUS.

It has been studied about the induction of experimental disease of thrombosis or disseminated intravascular coagulation (DIC) using small animals. The blood coagulation or fibrinolysis system in small animals are different from that of human.In present study, we investigated the coagulation and fibrinolysis systems of Japanese and Rhesus monkeys as compared with human.These monkey's coagulation system was very similar to that of human from the results of prothrombin time test, partial thromboplastin time test, thrombin time test and the level of fibrinogen, whereas the fibrinolysis system of these monkeys were different from that of human. That is, the plasma lysis time and euglobulin lysis time were extremely prolonged in comparison with that of human.The level of plasmin inhibitor (including antiactivator), however, was same as the human. And the concentration of plasminogen in plasma from monkeys was higher significantly (p